What Is a Thoracotomy?

A thoracotomy is when a surgeon goes between your ribs to get to your heart, lungs, or esophagus to diagnose or treat an illness.

It's a major operation, and doctors usually don’t use it if something simpler will work just as well. Your doctor might recommend a thoracotomy to:

  • Take out part or all of a lung or a growth on a lung
  • Reinflate a collapsed lung
  • Take out a blood clot, tumor, or lymph node
  • Repair your heart
  • Remove a cyst in your chest
  • Repair your diaphragm
  • Remove part of your chest wall

In the emergency room, medical teams sometimes need to do a thoracotomy if someone has a punctured heart.

How It's Done

A thoracotomy typically takes 3 to 4 hours, and the surgical team will give you medicine to make you sleep through it. When the operation gets underway, your surgeon will start with a cut around 6 inches long on your left or right side, just below the tip of your shoulder blade.

When she gets to the two ribs she’s aiming for, she’ll spread them apart a little to make room. She may cut through a rib to give her more room to work.

After your surgeon has finished her work, she'll put in tubes that you’ll have after the operation. One will drain fluid or air that may build up inside your chest, and another will let your medical team give you medicine.

Depending on what's being done, a mini-thoracotomy might be an option. With this, your surgeon goes between your ribs, just like in a regular thoracotomy, but she makes a cut that's only 2 to 3 inches long instead of 6 inches. Special instruments let her work through the smaller opening. This causes less pain than the full-scale surgery, and you get better faster.

One example of when your doctor might recommend this is if you have a heart valve that needs to be repaired.

How to Prepare

Well ahead of the surgery, you’ll have to start getting ready. For example, if you take any prescription medicine, you may have to switch drugs for a while. And a week before you go in, you should stop using painkillers like aspirin, ibuprofen, or naproxen. If you take aspirin for heart therapy, ask your doctor what to do.

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If you smoke, you'll need to quit at least 4 weeks before the surgery. Your surgical team may test you on the day of your surgery, and they’ll call it off if you’ve been smoking.

Go for a walk every day to build up your strength. Up to 2 or 3 miles a day is great if you can go that far. Your doctor also might give you a device called an incentive spirometer to exercise your lungs. Three times a day, you'll use it to breathe in deeply and then breathe out. Take it with you when you go in for your surgery.

The night before your surgery, don’t eat or drink anything after midnight.

After the Thoracotomy

After the surgery, you’ll spend several days in the hospital. You'll be able to give yourself pain medicine through in IV when you need it, and you'll get more medicine through the tubes the surgeon put in during surgery. (Your medical team will probably take these out before you go home.)

Your team will keep a close eye on you in case you have any issues, like bleeding, an infection, or an air leak from your lungs.

A nurse may wrap your legs in sleeves that help keep blot clots from forming while you’re on your back. It's also a good idea to do leg exercises while you're in bed. Point your toes toward the wall, then toward the ceiling. Or flex your feet around in circles. You'll also continue to do breathing exercises with the incentive spirometer.

When You Go Home

After you leave the hospital, it may take 4 to 6 weeks for you to feel up to your normal routine. Be patient.

Your doctor will give you pain medicine -- always take it with food. As you heal, you should gradually need less of it.

To speed your recovery and be more comfortable, you might:

  • Take warm showers to help ease pain once your doctor says it's OK. A heating pad can also help, but don’t put it directly on your skin.
  • Sleep in a recliner or on the sofa. When you first get home, soreness may make it hard for you to fall asleep in your bed.
  • Eat a well-balanced diet with plenty of protein.
  • Ease back into physical activity by going for walks, but pace yourself as your strength comes back.
  • Drink plenty of liquids, and eat a lot of fiber -- your pain medicine might make it hard for you to have bowel movements. You also can try an over-the-counter laxative.
  • Wash the area around the cuts gently with soap and water every day, but don’t bathe in the tub. Use the shower instead. Stay out of swimming pools and hot tubs.

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When to Call Your Doctor

As you recover at home, call your doctor if:

  • You have a temperature above 101 degrees.
  • The main cut swells, turns red, or feels hot to the touch.
  • Pus comes out of the cut.
  • Your stitches or staples pull loose.
  • You vomit a lot.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on July 23, 2019

Sources

SOURCES:

Merck Manual Consumer Version: “Thoracotomy.”

Journal of Thoracic Disease: “Open Thoracotomy for Pneumothorax.”

American Heart Association: “Your Aorta: The Pulse of Life.”

University of Michigan Health System: “Preparing for Your Thoracotomy.”

Cleveland Clinic: “Pulmonary Nodules: Management and Treatment,” “Minimally Invasive Mitral Valve Repair.”

Navicent Health: “Thoracotomy.”

World Journal of Emergency Surgery: “Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes.”

American Lung Association: “Thoracotomy.”

Multimedia Manual of Cardio-Thoracic Surgery: “Posterolateral thoracotomy.”

Christiana Care Health System: “Thoracoscopy/Thoracotomy Discharge Instructions.”

Annals of Thoracic Surgery: “The Minithoracotomy Approach: A Safe and Effective Alternative for Heart Valve Surgery.”

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